Step by step in pelvic endometriosis - MRI in correlation with the Enzian classification

Genital / Reproductive system female, Pelvis, MR, Education, Education and training Authors: M. Nedelea, B. Radu, M. Ciobanu, R.-A. Baz, C. Niscoveanu, R. O. Baz DOI: 10.26044/ecr2025/C-21779 Learning objectives The purpose of this paper is to correlate MRI imaging of endometriosis with the Enzian classification, and we propose to show this through a series of didactic cases so that the applicability of the Enzian classification to MRI is clear.

Endometriosis is a common pathology, affecting about 10% among women of reproductive age. MRI is the best imaging modality for presurgical mapping of pelvic endometriosis and for follow-up after medical or surgical treatment. In 2021, the Enzian classification was published, proposing a new comprehensive classification system of endometriosis, combining a complete staging of deep infiltrative endometriosis with the evaluation of peritoneal/ovarian/tubal localizations and the presence of adenomyosis, showing a good correlation between pre-operative MRI features and intraoperative findings in patients with endometriosis.Enzian Classification System OverviewThe... Findings and procedure details We report a series of cases with suggestive imaging aspects of endometriosis, with less common sites of involvement as well as complications, that allowed a preoperative diagnosis, specified by an Enzian-based structured MRI report. All our cases were evaluated using a specific MRI protocol for endometriosis: T2W sagittal, axial, coronal and T1fs, T1 ‘in-out of phase’; DWI and gadolinium contrast are used as optional techniques when there is suspicion of malignancy and infection. The most frequent findings were ovarian endometriomas (O), followed by deep infiltrating...

An Enzian-based structured MRI report is an exceptionally well-suited imaging modality that can contribute to the early and accurate diagnosis of endometriotic lesions, while also reducing the need for invasive procedures, guiding the attending physician so that the patient has the best prognosis. Personal information and conflict of interest M. Nedelea: Nothing to disclose B. Radu: Nothing to disclose M. Ciobanu: Nothing to disclose R-A. Baz: Nothing to disclose C. Niscoveanu: Nothing to disclose R. O. Baz: Nothing to disclose

1.Cristina Maciel, Hélder Ferreira, et al. MRI of endometriosis in correlation with the #Enzian classification: applicability and structured report. Insights into Imaging volume 14, Article number: 120 (2023)2.Jörg Keckstein, Ertan Saridogan, et al. The #Enzian classification: A comprehensive non-invasive and surgical description system for endometriosis. 23 January 2021 https://doi.org/10.1111/aogs.14099